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Trauma is the most common cause of death in young people, and head injury accounts for almost half of these trauma-related deaths. Head injury severity ranges from concussion to severe traumatic brain injury (TBI). Concussion is broadly defined as an alteration in mental status caused by trauma with or without loss of consciousness. The term concussion is often used synonymously with mild TBI. Grades of TBI are traditionally defined by the Glasgow Coma Scale (GCS) measured 30 minutes after injury (Table 24–7).

Table 24–7.Glasgow Coma Scale.1

Head trauma may cause cerebral injury through a variety of mechanisms (Table 24–8). Central to management is determination of which patients need head imaging and observation. Of particular concern is identification of patients with epidural and subdural hematoma, who may present with normal neurologic findings shortly after injury (lucid interval) but rapidly deteriorate thereafter, and in whom surgical intervention is life-saving.

Table 24–8.Acute cerebral sequelae of head injury.

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